Sharing Data from Pharmacy Information Systems

Jeff Barnett , BSc(Pharm), MSc, FCSHP

In a recent issue of the CJHP , Brisseau and others1 discussed the topic of sharing data from pharmacy information systems to electronic health records. I was dismayed by some of the misleading and inaccurate information presented in this letter.

I would first take issue with the number that the authors quoted from the Hospital Pharmacy in Canada Survey, suggesting that “6% of departments were using this type of medical record” [i.e., electronic health records].1 I seriously doubt this number and could not find its source anywhere in the published survey. In fact, Table J-5 of the survey report2 states an 81% achievement rate among pharmacists in using medication-relevant portions of patients’ electronic medical records for managing patients’ medication therapy. This rate of use necessarily implies that such electronic medical records actually exist. I suspect that the authors were confusing the rate of implementation of electronic health records with the rate of uptake of full-blown computerized order entry, which is probably in the range of 11%.3 In fact, most hospitals in Canada have some sort of electronic system that functions as an electronic health record. In addition, under the leadership of Canada Health Infoway, most provinces are deploying provincial electronic health records, which will be able to exchange data electronically with pharmacy systems.

The authors of the letter1 also state that “the American Society of Health-System Pharmacists has published a number of statements on robotization and information technologies, but neither the Canadian Society of Hospital Pharmacists nor any of the professional regulatory authorities in Canada have published professional guidelines for data maintenance or order exchange in health care settings.” This is not entirely true. Furthermore, such activities do not really fall within the CSHP’s role. I would also like to point out that Canadian versions of such guidelines actually do exist. In British Columbia and other provinces, there are specifications for electronic data interchange involving pharmacy systems and provincial networks like BC’s PharmaNet. Granted, in British Columbia, we currently deal only with community and outpatient pharmacies; however, there are plans to include data from hospital pharmacy systems as well. In addition, the Canadian Pharmacists Association (CPhA) has been actively involved with the Canadian Electronic Drug (CeRx) Messaging Standard, which deals with e-prescribing messages, dispensing messages, clinical messages (e.g., allergies), and other types of communication. In fact, Canada Health Infoway has an active standards group that is paying close attention to information exchange in the pharmacy context at the provincial level. The provinces are at differing levels of deployment, but the Maritimes (especially Newfoundland and Labrador and Prince Edward Island) are leading the way.

In the pilot study described in the letter by Brisseau and others,1 the authors found medication administration records, as a source of information for an electronic health record, to be fraught with many obstacles. However, this should not have been surprising. These records are designed for a specific purpose in the hospital environment and are not always the best source of dispensing information. I would agree with the authors’ suggestion that we are not ready to share information with inpatient and outpatient records, if such sharing of information were to rely solely on the use of medication administration records. But in Canada, we are clearly not looking at this type of record as the sole source of information. Many vendors of pharmacy clinical information systems are fully aware of the standards for electronic health records established by Canada Health Infoway. In most provinces, in fact, provincial electronic health records are based on these standards, and any vendor wishing to market a system that will integrate with the provincial records must follow the standards.

In conclusion, I would point out that I have been asked to represent the Canadian Society of Hospital Pharmacists (CSHP) on the National e-Pharmacy Task Force, which is composed of stakeholder groups such as the CSHP, the CPhA, and the National Association of Pharmacy Regulatory Authorities. The task group is fully engaged in discussions related to the issues raised in the letter.1 However, the e-health agenda is clearly here, and there is no doubt in my mind that we are already sharing data from pharmacy information systems and will continue to fine-tune the electronic exchange of pharmacy data.

Brisseau and others conclude their letter1 by stating, “In the meantime, to avoid slowing further development in the health care sector, safe data-sharing from pharmacy information systems to inpatient or outpatient electronic health records could rely on electronic sharing of actual labels (e.g., in pdf format).” In my view, this conclusion is irresponsible, a step backward at best, and potentially has the same flaws as using medication administration records.


1.  Brisseau L, Lebel D, Bussières JF. Are we ready to share data from pharmacy information systems to electronic health records? [letter]. Can J Hosp Pharm 2011;64(1):59–60.

2.  Musing E. CSHP 2015. In: Babich M, Bussières JF, Hall K, Harding J, Johnson N, Lefebvre P, et al, editors. Hospital pharmacy in Canada 2007/2008 report . Eli Lilly; 2008 [cited 2011 Mar 31]. p. 81–89. Available from:

3.  Barnett J, Jennings H. Pharmacy information systems in Canada. In: McDaniels JG, editor. Advances in information technology and communications in health. Fairfax (VA): IOS Press; 2009. p. 131–141.

Director, Clinical Informatics, BC Cancer Agency, Adjunct Assistant Professor, School of Health Information Science, University of Victoria, Victoria, British Columbia

[The authors respond:]

Denis Lebel , BPharm, MSc, FCSHP , Assistant Director , Jean-François Bussières , BPharm, MSc, FCSHP , Director

We thank Jeff Barnett for his interest in and comments about our recent letter to the editor.1

In that letter, there was a numeric error, but we also failed to provide complete details for the data cited. Specifically, the value of 6% that appeared in our letter should have been 7% ( n = 6), referring to implementation of complete electronic health records, including computerized prescriber order entry systems, for hospitals with 201–500 beds (such as ours), as reported in the 2007/2008 Hospital Pharmacy in Canada Survey (see Table H-3).2 Notably, increased values of 12% ( n = 11), for hospitals with 201–500 beds, and 8% ( n = 13), for all respondents, were reported in the Hospital Pharmacy in Canada Survey for 2009/2010 (see Table F-4).3 Although it is true that the proportion of health care institutions with complete electronic health records is on the rise, it is our understanding that most Canadian health care institutions use several systems, some with and others without electronic interfacing, for clinical monitoring of inpatients and outpatients. We will have to wait a few years before most institutions have access to fully integrated electronic health records.

As far as the various Canadian and provincial initiatives related to setting up electronic health records are concerned, we acknowledge their existence but would emphasize that they must be fully integrated into current products before their full effects will be realized. The Canadian Electronic Drug (CeRX) Messaging Standard is well designed and holds a lot of promise. This standard will make it possible to share complete information, provided that the information systems exchanging data respect all principles of the standard, which is often not the case.

While we wait for the implementation of compliant systems that can securely share all data related to patients’ drug records, we believe that sharing data from the medication administration record (rather than sharing electronic records based on incomplete, nonstandardized data from various systems that may have been transformed by algorithms) may be a good compromise. Furthermore, the challenge is not to show the feasibility of optimal data exchange, but rather to achieve safe information sharing.

We applaud Jeff Barnett’s participation as a CHSP representative on the National e-Pharmacy Task Force, which will help to mobilize pharmacists, institutions, and other stakeholders to promote the changes that will be required in order for information to flow safely from one system to another.


1.  Brisseau L, Lebel D, Bussières JF. Are we ready to share data from pharmacy information systems to electronic health records? [letter]. Can J Hosp Pharm 2011;64(1):59–60.

2.  MacGregor P. Technology. In: Babich M, Bussières JF, Hall K, Harding J, Johnson N, Lefebvre P, et al, editors. Hospital pharmacy in Canada 2007/2008 report. Eli Lilly; 2008 [cited 2009 Mar 31]. p. 67–76. Available from:

3.  MacGregor P. Technology. In: Babich M, Bussières JF, Hall K, Harding J, Johnson N, Lefebvre P, et al, editors. Hospital pharmacy in Canada 2009–2010 . Eli Lilly; 2010 [cited 2011 Mar 31]. p. 64–76. Available from:
pubmed  pmc  

Research Unit in Pharmacy Practice, CHU Sainte-Justine, Montréal, Quebec

Denis Lebel and Jean-François Bussières are also affiliated with the Department of Pharmacy, CHU Sainte-Justine. Jean-François Bussières is a clinical professor in the Faculty of Pharmacy of the Université de Montréal.

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Canadian Journal of Hospital Pharmacy , VOLUME 64 , NUMBER 3 , May-June 2011